CPT 29856 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 29856 |
National average reimbursement for CPT 29856 by major payers:
$1,355.03
$1,184.12
$1,031.52
$1,503.38
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 29856 | ||||||
United | 29856 | $4600.00 | 1154318103 - OPTUM CARE WASHINGTON PLLC, OPTUM - KEMP SURGERY CENTER | 910214500 - THE EVERETT CLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $3630.22 | 1417944778 - MERRIMACK VALLEY ENDOSCOPY CENTER | 43578297 - (MA) MERRIMACK VALLEY ENDOSCOPY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $4140.00 | 1346621893 - NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | 472128570 - (NJ) NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $4240.00 | 1447916259 - BJOSC, LLC, BJOSC, LLC @ WESTWOOD | 300391378 - BJOSC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $6588.00 | 1912265653 - BRASELTON ENDOSCOPY CENTER, LLC | 453369410 - (GA) BRASELTON ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $5716.60 | 1447221486 - ORTHOPAEDIC OUTPATIENT SURGERY CENTER, LLC | 421508092 - (IA) ORTHOPAEDIC OUTPATIENT SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $740.00 | 1639105455 - ENDOSURG OUTPATIENT CENTER LLC | 593678998 - (FL) ENDOSURG OUTPATIENT CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $6082.00 | 1992763932 - HEALTHEAST SURGERY CENTER-MAPLEWOOD, LLC, MAPLEWOOD SURGERY CENTER | 203349887 - (MN) HEALTHEAST SURGERY CENTERMAPLEWOOD LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $1064.00 | 1528000817 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $1.00 | 1619923661 - DELTA ENDOSCOPY CENTER, P.C. | 640903701 - (MS) DELTA ENDOSCOPY CENTER PC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $8071.00 | 1487136412 - ENDOSCOPY CENTER OF SOUTH SACRAMENTO, LLC, ENDOSCOPY CENTER OF SOUTH SACRAMENTO | 364904884 - (CA) ENDOSCOPY CENTER OF SOUTH SACRAMENTO LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $958.00 | 1275501512 - NORTHWEST KANSAS SURGERY CENTER, LLC | 481209668 - (KS) NORTHWEST KANSAS SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $7888.00 | 1275532889 - COAST SURGERY CENTER L P, COAST SURGERY CENTER OF SOUTH BAY | 450463066 - (CA) COAST SURGERY CENTER L P | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $6588.00 | 1790093813 - AZ WEST ENDOSCOPY CENTER LLC | 272343469 - (AZ) AZ WEST ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 29856 | $5963.00 | 1760907919 - BANNER SUN CITY WEST SURGERY CENTER LLC | 901182684 - (AZ) BANNER SUN CITY WEST SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 29856 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 29856 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 29856 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 29851-CPT | High | Arthroscopically Aided Treatment Of Intercondylar Spine(S) And/Or Tuberosity Fracture(S) Of The Knee, With Or Without Manipulation; With Internal Or External Fixation (Includes Arthroscopy) |
| 29855-CPT | High | Arthroscopically Aided Treatment Of Tibial Fracture Proximal (Plateau); Unicondylar Includes Internal Fixation When Performed (Includes Arthroscopy) |
| 29856-CPT | High | Arthroscopically Aided Treatment Of Tibial Fracture Proximal (Plateau); Bicondylar Includes Internal Fixation When Performed (Includes Arthroscopy) |
| 29866-CPT | High | Arthroscopy, Knee, Surgical; Osteochondral Autograft - Medicaid Rn Review>=6/13/2009. Commercial Rn Review=6/13/2009-3/31/2022 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 29856. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 29856 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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